High expression of CXCR7 combined with Alpha fetoprotein in hepatocellular carcinoma correlates with extra-hepatic metastasis to lung after hepatectomy

The lung is the most frequent metastatic site of hepatocellular carcinoma (HCC), negatively impacting on survival rates. In this study, we evaluated the prognostic role of the chemokine receptor CXCR7 in lung metastasis of HCC after hepatectomy, using immunohistochemical detection on tissue microarrays of HCCs, with and without lung metastasis. Using three categories based on staining characteristics, patients with high CXCR7 expression demonstrated a shorter time to development of lung metastasis compared with patients with low CXCR7 expression (log-rank test) with no effet on overall survival. Analysis of tissue adjacent to tumor showed patients with microvascular invasion to have higher CXCR7. Stratification based on alpha fetoprotein level >20 ng/ml also showed high expression of CXCR7 to be a strong independent prognostic factor. These findings suggest that high expression of CXCR7 in HCCs with elevated alpha fetoprotein levels correlates with metastasis to lung and poor survival after hepatectomy, indicating potential use as a prognostic factor.

Abstract P5-15-05: Applicability of Breast Cancer Guidelines and Knowledge Translation in a Community Oncology Setting

Background: The quality of a guideline may impact adherence to that guideline. Cancer Care Ontario (CCO) produces guidelines to help manage all stages of disease. CCO's staging and follow-up guideline suggests patients (pts) with stage I breast cancer require no further staging investigations, bone scan for stage II disease, and for stage III disease in addition to bone scan, chest and abdominal imaging. The guideline on bisphosphonate (BP) use in metastatic breast cancer pts indicates that all pts with bone metastases should be offered a BP. We assessed the efficacy of knowledge translation of these guidelines at a community oncology centre by correlating rate of adherence with the quality of the guideline as scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.

Methods: The quality of 2 breast cancer guidelines from CCO were assessed using the AGREE instrument. Two cohort studies of breast cancer pts seen were then conducted to evaluate the adherence to these guidelines. Specifically, staging investigations ordered on pts seen in our multidisciplinary clinic between January 2009 and April 2010 were recorded and correlated to pathological stage of disease. Our second cohort study reviewed breast cancer pts with bone metastases who died between 1999 and 2009, and initiation of a BP was recorded in order to determine adherence to the second guideline.

Results: Inadequate adherence was identified and correlated with low applicability scores for these two guidelines (58% and 33% respectively). Only 68 pts (61%) with bone metastases received BP for treatment between 1999 to 2009. 129 pts (56%) underwent unnecessary staging investigations.

Discussions: Non-chemotherapy breast cancer guidelines by CCO scored low in the field of applicability; this was confirmed by two retrospective cohort studies. Improvement in knowledge translation strategies are needed to improve adherence to practice guidelines set out by this national organization.

Protocol optimization for long-term liquid storage of goat semen in a chemically defined extender

A specific problem in the preservation of goat semen has been the detrimental effect of seminal plasma on the viability of spermatozoa in extenders containing egg yolk or milk. The use of chemically defined extenders will have obvious advantages in liquid storage of buck semen. Our previous study showed that the self-made mZAP extender performed better than commercial extenders, and maintained a sperm motility of 34% for 9 days and a fertilizing potential for successful pregnancies for 7 days. The aim of this study was to extend the viability and fertilizing potential of liquid-stored goat spermatozoa by optimizing procedures for semen processing and storage in the mZAP extender. Semen samples collected from five goat bucks of the Lubei White and Boer breeds were diluted with the extender, cooled and stored at 5 degrees C. Stored semen was evaluated for sperm viability parameters, every 48 h of storage. Data from three ejaculates of different bucks were analysed for each treatment. The percentage data were arcsine-transformed before being analysed with anova and Duncan's multiple comparison test. While cooling at the rate of 0.1-0.25 degrees C/min did not affect sperm viability parameters, doing so at the rate of 0.6 degrees C/min from 30 to 15 degrees C reduced goat sperm motility and membrane integrity. Sperm motility and membrane integrity were significantly higher in semen coated with the extender containing 20% egg yolk than in non-coated semen. Sperm motility, membrane integrity and acrosomal intactness were significantly higher when coated semen was 21-fold diluted than when it was 11- or 51-fold diluted and when extender was renewed at 48-h intervals than when it was not renewed during storage. When goat semen coated with the egg yolk-containing extender was 21-fold diluted, cooled at the rate of 0.07-0.25 degrees C/min, stored at 5 degrees C and the extender renewed every 48 h, a sperm motility of 48% was maintained for 13 days, and an in vitro-fertilizing potential similar to that of fresh semen was maintained for 11 days.

4-Phase-Rhinomanometry (4PR)--basics and practice 2010

The last comprehensive publications about the theory and practice of rhinomanometry appeared more than 20 years ago. Since the 1980's, the general progress of sensor techniques, fluid physics and data processing was accompanied by the permanent work of the authors to analyze the errors of rhinomanometry and to create a fundament for a contemporary and practical method that can be used in functional diagnostics of the nasal air stream. In this special document, the objectives and measurement principles, as well as the history of rhinomanometry are described in the first three chapters. It is pointed out, that the key parameters are not only intranasal pressure and flow, but also the factor time. The technical requirements as following from the dynamics of breathing are described. The process of averaging of rhinomanometric data lead to a separate and time-dependent analysis of the changes of pressure and flow and implicated the introduction of the 4 breathing phases (ascending and descending curve part in inspiration and expiration) into rhinomanometry and is therefore called 4-Phase-Rhinomanometry (4PR). Chapter 4 is containing a comprehensive analysis of the practical errors, which may follow neglecting the 4 breathing phases. The in chapter 5 described mathematical-physical concept of 4PR is based on the introduction of the terms "steady" and "unsteady" flow, in addition to the up to now used terms of laminarity and turbulence. After the derivation of the HOFFRICHTER-equation as explaining the loops around the intersection point of the x-axis and y-axis, a clinical classification of the rhinomanometric findings is given and confirmed by physical experiments with "artificial noses". Finally, testing the rhinomanometric method by CFD (Computational Fluid Dynamics), lead to the same conclusions as to the importance of 4 phases of the breathing cycle. The precondition for the worldwide introduction of new parameters into the 4PR is a comprehensive statistical analysis. The disadvantages of the present recommended standard values are described in chapter 6. Following previous studies in 5800 cases, the parameters Vertex Resistance (VR), Effective Resistance (Reff) and their logarithmic transformations have been investigated in 1580 rhinograms of different degrees of obstructions, also including the correlations to a VAS. It could be confirmed, that the parameters VR and Reff after logarithmic transformation, have a significant and high correlation to the sensation of obstruction. The new clinical classification of obstruction and conductance of the nose is proposed in Table 1 for Caucasian noses. Table 1. Clinical classification of obstruction and conductance for Causcasian noses. [see text for table]. Chapter 7 is dedicated to the advantages of 4PR in the functional diagnosis of nasal valve problems. Graphical as well as numerical solutions are available by the fact, that the motions of the nasal entrance as caused by the breathing process are now visible from the shape of the 4PR-curve. Discussing practical aspects in chapter 8, the start point of proposals and discussions are the standard recommendations of the ISOANA and the results of its consensus conference in 2003. In particular the calibration processes, hygiene, the correct attachment of the pressure tube at the nostril ("tape method") and the different measurement procedures (AAR, APR), decongestion and provocation tests are extensively described. Both the final chapters are clinical contributions from mainland China, which are of high importance because of the racial differences in nasal respiratory function. In chapter 9, tests of the assessment of normal nasal airway in adult Chinese by 4PR, rhinomanometry and acoustic rhinometry are presented. This investigation lead to the conclusion that 4PR is an important supplement to classic rhinomanometry and acoustic rhinometry, if the classification of obstruction is adapted to the higher basic resistance of the Chinese population. Chapter 10 is dealing with 4PR and acoustic rhinometry in the functional evaluation of septal deviations and concludes, that both methods are valuable objective instruments for the evaluation of nasal obstruction.

A randomized phase II study of FOLFOX or FOLFIRI.3 as second-line therapy in patients with advanced pancreatic cancer previously treated with gemcitabine-based chemotherapy

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Background: Only few clinical trials have been conducted in patients with advanced pancreatic cancer after failure of first-line gemcitabine-based chemotherapy. We conducted a randomized phase II trial of modified FOLFOX vs. modified FOLFIRI.3 as second-line regimen for the patients with gemcitabine refractory pancreatic cancer ( NCT00786006 ). Methods: Patients with advanced pancreatic adenocarcinoma previously treated with gemcitabine were randomly assigned to FOLFOX or FOLFIRI.3 stratifying by age (≤ 65 vs. >65), performance status (0–1 vs. 2) and prior response to gemcitabine (PR/SD vs. PD). FOlFIRI.3 regimen consisted of Irinotecan 70 mg/m2 (over 60 min) D1, leucovorin 400 mg/m2 (over 2h) D1, 5-FU 2000 mg/m2 (over 46 hours) from D1, then irinotecan 70 mg/m2 (over 60 min) at the end of the 5-FU infusion every two week. FOLFOX regimen is composed of oxaliplatin 85 mg/m2 (over 120 min) D1, LV 400 mg/m2 D1, 5-FU 2,000 mg/m2 (over 46 hours) every two week. The primary end-point was 6-month overall survival (P0=20%) and Simon-Wittes-Ellenberg design was used to calculate the sample size (29 evaluable patients for each treatment arm). Results: From January 2007 to December 2008, sixty patients were enrolled and randomized to FOLFOX (N=30) or FOLFIRI.3 (N=30). Baseline characteristics were well balanced between each arm; median age 56 (35–60) vs. 56 yo (37–73); ECOG PS 0/1/2, 5/24/1 vs. 5/25/0; prior response to gemcitabine-based chemotherapy PR/SD/PD 10/13/7 vs. 10/11/9. With a median follow-up period of 6.0 months (95% CI, 4.7–7.3) the median overall survival was 4.0 months in both group (HR=0.95, 95% CI 0.52–1.75) with 6-month survival rates of 25% and 20%, respectively. The median PFS was 1.4 months for FOLFOX and 1.9 months for FOLFIRI.3 (HR=1.11, 95% CI, 0.64–1.92). Disease control (PR+SD) was achieved in 20% (5/25 in FOLFOX) and 28% (7/25 in FOLFIRI.3) of patients with measurable disease. The incidences of grade 3/4 toxicities were similar in both groups. Conclusions: Both FOLFOX and FOLFIRI.3 were tolerated with manageable toxicity, offering modest activity as second-line treatment of patients with advanced or metastatic pancreatic cancer, previously treated with gemcitabine.

No significant financial relationships to disclose.

The optimal threshold of 18F-FLT PET and 18F-FDG PET to estimate the length of gross tumor volume in patients with squamous cell carcinoma of the thoracic esophagus verified by pathological examination

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Background: To determine the optimal method of using 3-deoxy-3-18F-fluorothymidine (FLT) positron emission tomography (PET) to estimate gross tumor length in esophageal carcinoma, and compared with that of 18F- fluorodeoxyglucose(FDG) PET. Methods: Twenty patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled and detected by FLT PET, eighteen of them underwent FDG PET scan. Gross tumor volumes (GTVs) were delineated using seven different methods with FLT PET: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, and 20% of maximum standard uptake value (SUVmax), 25% SUVmax,30% SUVmax, on FLT PET imaging, and three different methods with FDG PET: visual interpretation, SUV 2.5, and 40%SUVmax on FDG PET imaging. The length of tumors on FLT PET scan were measured and recorded as LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%, and FDG PET scan were measured and recorded as LFDGvis, LFDG2.5, and LFDG40%, respectively, and compared with the length of gross tumor in the resected specimen measured by pathological examination (LPath). Results: The mean (±SD) LPath was 5.16±2.19cm. The mean LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%were 5.17±2.40cm, 5.55±2.43cm, 5.17±2.41cm, 4.95±2.44cm, 5.82±2.23cm, 5.32±2.31cm, and 5.04±2.28cm, respectively. Compared with the LPath, the P value were 0.971, 0.045, 0.972, 0.255, 0.066, 0.644, and 0.714, respectively. The correlation coefficients were 0.952, 0.944, 0.959, 0.948, 0.763, 0.783, and 0.800, respectively. The mean LFDGvis, LFDG2.5, and LFDG40% were 5.41±2.27cm, 5.38±2.25cm, and 4.02±1.57cm, respectively. Compared with the LPath, the P value were 0.098, 0.085 and 0.000, respectively. The correlation coefficients were 0.984, 0.990 and 0.932, respectively. On FLT PET, LFLT1.4, and on FDG PET, L FDG2.5 seem more approximate to LPath. The difference between LFLT1.4 and LFDG2.5 was not significantly (P=0.442), the correlation coefficients was 0.960. Conclusions: An SUV cutoff of 1.4 on FLT PET, and an SUV cutoff of 2.5 on FDG PET, provided the closest estimation of GTV length in this study

No significant financial relationships to disclose.

Phase II trial of neoadjuvant fixed dose rate (FDR) gemcitabine with capecitabine (GX) combination chemotherapy in locally advanced pancreatic adenocarcinoma (LAPA)

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Background: To determine the efficacy and safety of fixed dose rate (FDR) gemcitabine and capecitaibne (GX) combination chemotherapy for locally advanced pancreatic adenocarcinoma Methods: Patients with histologically confirmed LAPA were eligible for this prospective phase II trial. Dynamic pancreas/pelvic CT, MRI and FDG-PET were undertaken to assess the resectability. EUS was also performed as needed basis. ‘Borderline resectable (BR)’ and ‘unresectable (UR)’ criteria developed by our pancreatico-biliary multidisciplinary management team (PBMMT) and NCCN criteria were used. After confirmation of resectability, patients received 3 cycles of FDR gemcitabine 1,250 mg/m2 on D1 and D8 and capecitabine 950 mg/m2 from D1-D14 every 3 weeks. Thereafter, staging was repeated and patients underwent surgery if the disease was not unresectable. For patients with R0 resection, additional 6 cycles of GX were administered. For patients with R1 resection, chemoradiotherapy (CRT) (54 Gy over 5 weeks with concurrent 5-FU and leucovorin or capecitabine) followed by FDR-GX was administered. Patients with stable or better response to chemotherapy but assessed unresectable at reassessment received additional chemotherapy up to 9 cycles followed by CRT. Results: Between August 2006 and July 2008, 38 eligible patients (14 with BR and 24 with UR based on NCCN criteria; 29 with BR and 9 with UR based on our PBMMT criteria) entered on this study. The median age was 61 yo (42–76) and 71% had cT4 disease. The response to neoadjuvant chemotherapy was PR in 6 (16%), SD in 26 (68%) and PD in 3 (8%). Metabolic response was achieved in 20 patients (53%) with 2 metabolic CR out of 31 evaluable patients. Grade 3 or worse adverse effects were mainly HFS (n=5) and gastrointestinal (n=3) with no grade 4 in severity. Surgery was performed in 9 patients (24.0%, R0=8, R1=1, 6 in NCCN-BR and 3 in NCCN-UR, 9 in PBMMT-BR) and five patients refused surgery although their diseases seemed not to be unresectable. The median PFS was 9.4 months (95% CI, 8.3–10.4) and estimated median OS was 13.5 months (95% CI, 12.4- 14.5). Conclusions: FDR-GX was effective as neoadjuvnat chemotherapy in LAPA with favorable toxicity profile.

No significant financial relationships to disclose.